Provider Demographics
NPI:1679585475
Name:AZIZI, SAFIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAFIA
Middle Name:
Last Name:AZIZI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 RACINE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8702
Mailing Address - Country:US
Mailing Address - Phone:910-332-0687
Mailing Address - Fax:910-332-0689
Practice Address - Street 1:215 RACINE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8702
Practice Address - Country:US
Practice Address - Phone:910-332-0687
Practice Address - Fax:910-332-0689
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990131Medicaid